Department of Radiation Oncology, German Bone Research Group, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
Radiat Oncol. 2013 Aug 13;8(1):200. doi: 10.1186/1748-717X-8-200.
The objective of this retrospective analysis is to systematically assess osseous lesions on the basis of a validated scoring system in terms of stability and fractures prior to and following radiotherapy in 338 lung cancer patients with bone metastases in the vertebral column.
The stability of 338 patients with 981 osteolytic metastases in the thoracic and lumbar spine was evaluated retrospectively on the basis of the Taneichi-Score between January 2000 and January 2012.
64% (215 patients) were classified stable prior to radiotherapy. Of the stable osseous metastases, none were rated unstable in the further course (p < 0.001, McNemar test). Of the 123 patients in whom the metastases were classified unstable prior to radiotherapy, 21 patients (17%) were classified stable after three months, and 30 patients (24%) stable after six months. A pathological fracture was diagnosed in 62 patients (18%) prior to radiotherapy. Regarding cases of osteolytic metastases of the vertebral bodies in which no fractures could be detected prior to the start of therapy, fractures occurred in 2% of all patients (n = 7) within six months following radiotherapy.
Our analysis demonstrated that pathological fractures following radiotherapy occur in the very minority of vertebral lesions for patients with a favorable outcome. The use of a systematic radiological scoring system to classify osteolytic metastases of the vertebral column has shown to be feasible in daily routine. Prospective clinical trials are warranted in order to analyse, to what extent patients with osseous metastases can be mobilized by physiotherapy for strengthening the paravertebral muscles before radiotherapy effects can be measured by means of radiological recalcification.
本回顾性分析的目的是通过一种经过验证的评分系统，系统地评估 338 例脊柱骨转移肺癌患者放疗前后脊柱骨溶骨性病变的稳定性和骨折情况。
根据 Taneichi 评分，回顾性评估 2000 年 1 月至 2012 年 1 月期间 338 例胸腰椎骨溶骨性转移患者的稳定性。
64%（215 例）患者在放疗前被分类为稳定。在稳定的骨转移中，无进一步进展为不稳定（p<0.001，McNemar 检验）。在放疗前被分类为不稳定的 123 例患者中，21 例（17%）在 3 个月后被分类为稳定，30 例（24%）在 6 个月后被分类为稳定。在放疗前诊断为 62 例（18%）患者发生病理性骨折。对于在开始治疗前没有发现椎体骨溶骨性转移骨折的病例，在放疗后 6 个月内，所有患者中有 2%（n=7）发生骨折。
我们的分析表明，在预后良好的患者中，放疗后发生病理性骨折的情况非常少见。使用系统的放射学评分系统对脊柱溶骨性转移进行分类，在日常工作中是可行的。需要进行前瞻性临床试验，以分析在放射学再钙化测量放疗效果之前，有多少骨转移患者可以通过物理治疗来增强椎旁肌肉的力量。
